RENAL CONSEQUENCES OF DEEP ENDOMETRIOSIS AFFECTING URINARY TRACT

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https://storage.unitedwebnetwork.com/files/1099/949fda3e1550203e06eb398d8cf30c71.pdf

Abstract Title

First Name *

Michael

Last Name *

Fanta

Co-author 1

Kvetoslav Novak kvetoslav.novak@vfn.cz 1st Faculty of Medicine of Charles University and General University Hospital Dept. of Urology Praha 2

Co-author 2

Michal Pesl michal.pesl@vfn.cz 1st Faculty of Medicine of Charles University and General University Hospital Dept. of Urology Praha 2

Co-author 3

Lucie Fantova lucie.fantova@volny.cz Nefrologie s.r.o. Nephrology Praha 4

Co-author 4

Lucie Hornova lucie.hornova@nefrologie-praha.cz Nefrologie s.r.o. Nephrology Praha 4

Co-author 5

Zdenka Lisá zdenka.lisa@vfn.cz 1st Faculty of Medicine of Charles University and General University Hospital Dept. of Gynaecology, Obstetrics and Neonatology. Praha 2

Co-author 6

Co-author 7

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

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Introduction

Deep endometriosis (DE) of urinary tract presents 1-2% of women with endometriosis. Urinary bladder (in 85%) and ureters (in 10%) are affected the most frequently. Possible consequences can be very serious especially in ureter´s affection leading to hydronephrosis and finally to loss of organ.

Methods

Retrospective evaluation of prospective follow-up of patients underwent surgery for deep endometriosis affecting ureters and leading to hydronephrosis

Results

We present study group of 66 patients surgically treated for DE affecting ureter. In 7 (8) patients both organs – ureter and bladder were affected. In ureter´s affection advanced ureterolysis, ureter resection with anastomosis – ureterorraphy or ureterocystoneoanastomosis (UCNA) was performed. In our study group is a large proportion of patients (n=8) underwent unilateral nephrectomy for complete loss of kidney fuction showing the problem of late diagnosis. In 10 cases bilateral affection has occurred. Three patients have arterial hypertension of renal etiology. Overall postoperative outcomes are favourable with recurrent surgery in three cases of patients with ureteral affection- once for hematuria 2 years after ureteral resection and anastomosis, once for restenosis after ureteral resection and anastomosis UCNA was performed, in third case 6years after resection and anastomosis ureterolysis was needed. In 8 cases arterial hypertension of renal etiology was diagnosed. In one case we observed strongly reduced of renal parenchyma and kidney function 10 years after ureter resection with ureterorrhaphy. Assymetry of the kidneys with only slightly reduced renal parenchyma on affected side has occurred in 7 cases in a long time period of follow-up.

Conclusions

Surgical outcomes of urinary tract endometriosis are generally satisfactory, but it should be early diagnosed before loss of the kidney function or cardiovascular complications development (arterial hypertension) in case of ureter´s affection. Adequate follow-up optimally by nephrologists skilled in doppler evaluation of renal function is important after surgery as well because of possible long-term impact of the disease on suffered kidney.

Supported by grant of General University Hospital, project GIP-23-L-03-223

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